Throughout the past two decades, members of the orthopaedic community have studied the pros and cons of post-operative functional bracing after ACL reconstruction surgery. Traditional protocol calls for patients to leave the operating room with a knee immobilizer after ACL reconstruction. Six weeks latter, they get fitted for a functional ACL brace. A 2003 survey of members of the American Orthopaedic Society for Sports Medicine (AOSSM) revealed that only 13 percent of respondents never braced their ACL reconstructed patients. However, the results of a 2012 study published in the Journal of Bone and Joint Surgery indicate that wearing a knee brace following anterior cruciate ligament (ACL) surgery has no effect on a patient’s recovery. In contrast, physiotherapy, ideally beginning a few days after surgery, produces better results.
To Brace or Not To Brace
A June, 2013 study examined the long term effects of wearing a knee brace after ACL surgery versus using no brace at all. The research team randomly assigned 64 ACL surgery patients into two groups. randomized 64 patients who had ACL surgery into 2 groups. One group used a post-operative brace after surgery, and the other did not.
Four years latter, the research team measured ACL ligament integrity and pain levels, and x-ray pictures in each patient. There was no difference in ligament integrity between groups. However,
the patients who did not use a knee brace after surgery reported less pain during sports. In contrast to the brace group, who experienced other injuries in the years following the surgery, the no-brace group was injury free.
Types of ACL Braces
Here are some of the different types of knee braces that are often prescribed after ACL surgery:
• The Knee immobilizer, as its name implies, prevents the knee joint from moving. This long cloth brace extends the length of the shin and thigh. Its insides and outsides have metal struts, whilst velcro straps hold the knee stabilizer in place.
• The Patella control brace is less restrictive than the knee stabilizer. It is a simple neoprene sleeve, which slips over the knee. This type of brace has a cutout that exposes the patella. It keeps the patella in the proper place during activities like walking, running, or squatting.
• Bledsoe brace is often used to stabilize the knee after ACL surgery. Its straps wrap around the thigh and shin, and its metal support brackets on the inside and outside part of the knee joint. The Bledsoe brace has a locking mechanism, which locks the knee into full extension.
What the Research Tells Us
In the study published in the Journal of Bone and Joint Surgery (JBJS), a team of orthopaedic surgeons reviewed 29 research papers about post ACL surgery treatment modules. The cumulative results of these papers indicate that physical therapy, begun shortly after surgery, delivers excellent outcomes for patients. Knee bracing, however, did not produce significant results.
Other findings include:
• Physical therapy should start early, within a few days after surgery.
• Therapies focusing on proprioception (awareness of movement of one’s body) may have benefits
• Balance therapies also may also help
• No vitamins or other supplements have been proven to have any effect on ACL healing.